Provider Demographics
NPI:1942333273
Name:JENKINS, WALTER HOUSTON JR (PA - C)
Entity Type:Individual
Prefix:MR
First Name:WALTER
Middle Name:HOUSTON
Last Name:JENKINS
Suffix:JR
Gender:M
Credentials:PA - C
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Mailing Address - Street 1:3901 N ROXBORO ST
Mailing Address - Street 2:SUITE 701
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27704-2181
Mailing Address - Country:US
Mailing Address - Phone:919-479-9888
Mailing Address - Fax:919-479-9882
Practice Address - Street 1:3901 N ROXBORO ST
Practice Address - Street 2:SUITE 701
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27704-2181
Practice Address - Country:US
Practice Address - Phone:919-479-9888
Practice Address - Fax:919-479-9882
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2012-12-03
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Provider Licenses
StateLicense IDTaxonomies
NC103931363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2022549Medicare PIN